Family Medicine
Question: My sister-in-law says that if she doesn’t have her morning cappuccino from a certain coffee store, she will get a migraine. We were traveling recently, and she was not able to get her specific coffee-store cappuccino.
I offered her other forms of caffeine, like coffee from elsewhere, but she wouldn’t drink it and got her headache.
Can this really happen or was she putting me on?
Answer: It sounds to me like your sister-in-law is suffering from morning caffeine withdrawal symptoms. This type of physical addiction to caffeine is fairly common. Despite its prevalence, however, there’s a lot of misunderstanding about caffeine in our society. Let me give you some facts.
Caffeine is the most widely used mood-altering drug in the world. It is one of the principal chemicals in coffee, tea, some sodas, chocolate and many medications. In the United States, about 90 percent of adults and children use caffeinated beverages on a regular basis. The average daily intake is about 280 mg, but as little as 30 mg per day can be mood altering.
Many problems have been associated with caffeine use. One of these is caffeine withdrawal. The headaches that you mentioned are the most common symptom. They are usually severe, and over 50 percent of people who are heavy caffeine users experience these headaches. Caffeine withdrawal can also cause fatigue or drowsiness, mental depression, irritability and difficulty concentrating. In some cases, it can even produce flu-like symptoms such as nausea, muscle pain, and stiffness.
Other problems related to the use of this drug include caffeine intoxication, caffeine-induced insomnia, and caffeine-induced anxiety disorders. Its use has also been linked with the worsening of conditions such as panic attack, anxiety, gastroesophageal reflux (GERD) and urinary difficulties. Many people with high blood pressure and heart trouble are advised to stop drinking coffee.
Some people, especially those who are not regular caffeine users, do get an energy boost from ingesting some caffeine. Many regular caffeine users also get a morning boost after being without caffeine overnight. Some experts feel that the morning coffee in regular users just helps to stop the caffeine withdrawal symptoms rather than give an actual energy boost.
If you take in too much caffeine and become intoxicated, you may suffer symptoms such as anxiety, rapid pulse, rapid speech, upset stomach, tremors and frequent urination. This will usually resolve in a few hours if no more caffeine is consumed. This is sometimes seen in college students during exam time.
An indication of the truly addictive nature of caffeine is the inability of many people to cut down. Some even continue to use caffeine in spite of advice from their physician that it will aggravate a medical condition they have. Others won’t cut down to avoid withdrawal.
Abrupt withdrawal can produce severe symptoms in some. Others will have no symptoms. That’s why it is best to gradually cut down on your caffeine intake over several days.
As for your sister-in-law, any product with a similar amount of caffeine should prevent a caffeine withdrawal headache. Her need for a specific coffee shop brand is a sign that her caffeine addiction has a psychological component to it.
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Family Medicine(r) is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio, 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions.
Past columns are available online at www.familymedicinenews.org.)